=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982394490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELEVATED SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2023
-----------------------------------------------------
Last Update Date | 05/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 W GRAYSON ST STE 150
-----------------------------------------------------
City | GALAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24333-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-239-5142
-----------------------------------------------------
Fax | 833-959-1670
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1032
-----------------------------------------------------
City | CHRISTIANSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24068-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-239-5142
-----------------------------------------------------
Fax | 833-959-1670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JENNIFER MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-250-7029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------